Screening for advanced liver disease in type 2 diabetes: time for systematic implementation

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is closely linked to type 2 diabetes (T2DM), patients with the latter being a population at particularly high risk of disease progression. Despite the availability of simple and validated non-invasive tools, the systematic identification of liver disease in patients with T2DM remains limited in routine practice. In this context, the study by Amiama et al. provides relevant prospective real-world evidence supporting the stepwise screening strategy proposed in the EASL-EASD-EASO guidelines for MASLD, based on initial FIB-4 assessment followed by transient elastography. This approach proved feasible and effective in identifying a substantial proportion of patients with previously unrecognised clinically relevant liver disease, including advanced fibrosis and other liver conditions. Beyond its diagnostic performance, the study highlights a persistent gap between evidence and daily practice. The main barrier is no longer a lack of diagnostic tools, but their limited integration into routine care pathways. Incorporating structured screening strategies into the standard management of T2DM should therefore be considered a necessary step rather than an optional approach. The expanding therapeutic landscape of MASLD further reinforces the importance of early detection, both to identify patients at higher risk and to guide treatment decisions. The challenge now lies in the systematic implementation of these strategies across different levels of care, moving from awareness to consistent action.